Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A5614 | CA |
N | 207Q00000X | Family Doctor | 20A5614 | CA |
NPI | 1356448237 |
---|---|
Provider Name | Sandra Beth Skates |
First Address | Vacaville, CA 95687-3508 |
Second Address | Vacaville, CA 95687-3508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 06/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E78625 | (02) | CA |